| NPI | 1790120822 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 292750) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2016-01477) |
| Enumeration Date | 2013-05-02 |
| Last Update Date | 2023-01-12 |